Conceptualized and directed by a five-member research team (the majority of whom are primary consumers) as a three-phase process (i.e. grounded theory inquiry concerning the phenomenon of recovery; creation of prototype systems-level performance indicators; and large-scale pilot testing), Phase One and Two have been completed. This briefing summarizes the research process and resulting ROSI measure.

Phase One involved a grounded theory, multi-site qualitative design to identify the person-in-environment factors that help or hinder recovery for people experiencing severe and persistent mental illness. Nine SMHAs used purposive sampling to recruit 115 consumers that participated in 10 structured focus groups. Researchers used rigorous, constant and comparative analytic methods involving qualitative coding, codebook development, cross coding and recoding of the focus group transcripts to develop a single set of findings. All nine SMHAs conducted member checks with focus group participants regarding the coding report for their respective focus group. The research achieved a “confirmability index” (agreement that the coding captured the original content) of 99.47% among the 59 who responded (51% of the original sample).

A conceptual paradigm for organizing and interpreting the phenomenon of mental health recovery emerged from the findings. While recovery is a deeply personal journey, there are many commonalities in people’s experiences. Recovery is facilitated or impeded through the dynamic interplay of many forces that are complex, synergistic, and linked. Recovery is a product of dynamic interaction among characteristics of the individual (self-agency, holism, hope, a sense of meaning and purpose), characteristics of the environment (basic material resources, social relationships, meaningful activities, peer support, formal services and staff), and the characteristics of the exchange (hope, choice, empowerment, referent power, independence, interdependence). Each of these emergent domains/themes contain a rich and complex network of helping and hindering elements.

In Phase Two, the research team used these findings to develop recovery oriented performance indicators. Two sets emerged, 73 consumer self-report data items and 30 administrative data items. In partnership with the participating states, the team refined the self-report set based on consumer review (a Think Aloud process) and a readability check and then conducted a prototype indicator test involving a diverse cross-section of 219 consumer/survivors in seven states. The research team then used the prototype self-report data results to evaluate each item as to: (a) importance rating, (b) factor loading values within a varimax rotated component matrix, (c) response scale distribution and direction, (d) Phase One originating theme, (e) items assessing similar content, (e) clarity of wording, and (f) Phase One member check priorities. Selected demographic variables (e.g., housing status; parent status, etc.) were also cross-tabbed with selected item importance mean ratings to determine whether significant differences exist and therefore if an item should be retained or specified for a particular subpopulation.

The research team generated specific measure definitions (i.e. numerators and denominators) for the administrative data items. The 10 participating SMHAs and the National Association of Consumer/Survivor Mental Health Administrators (NAC/